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CSC BMT Outpt BEEAM Bendamustine/Cytarabine/Etoposide/Melphalan Ver 11-17-17 (HL 6103)

CSC BMT Outpt BEEAM Bendamustine/Cytarabine/Etoposide/Melphalan Ver 11-17-17 (HL 6103) - Clinical Hub, UW Health Clinical Tool Search, UW Health Clinical Tool Search, Beacon Protocols, BMT


CSC BMT OUTPT BEEAM BENDAMUSTINE/CYTARABINE/ETOPOSIDE/MELPHALAN VER: 11-17-17 –  Properties
Conditioning Regimen Prior to BMT –  11/16/2017 through 11/29/2017 (14 days), Planned
Day -7, Conditioning Regimen Prior to BMT –  Planned for 11/16/2017
Treatment Plan Information
Reference Information (1)
BMT (AUTOLOGOUS): Visani G, et al. Blood 2011;118(12):3419-25.
Reference Information (2)
BMT (AUTOLOGOUS): Visani G, et al. Blood 2014;124(19):3029-31.
Reference Information (3)
BMT (AUTOLOGOUS): Gisselbrecht C, et al. J Clin Oncol 2010;28(27):4184-91.
Treatment Plan Summary
DISEASE: Hodgkin or Non-Hodgkin Lymphoma; THERAPY: bendamustine 200 mg/m2 IV Day -7 and -6, etoposide 200
mg/m2 IV Day -5, -4, -3 and -2, cytarabine 400 mg/m2 IV Day -5, -4, -3 and -2, melphalan 140 mg/m2 IV Day -1,
GROWTH FACTOR REQUIRED; CYCLE LENGTH: 14 days; COURSE: 1 cycle.
Dose Calculation Instructions
All chemotherapy for BMT conditioning regimens should be dosed based on the medication-specific weight in
Standard Operating Procedure (SOP) B4.400: Calculation of High Dose Chemotherapy Doses. Document can be
accessed from the Reference Link of the Navigator.
Consent
Verify Consent
Verify informed consent has been obtained.
IV Access
Insert and Maintain Peripheral IV
CONTINUOUS Starting when released Until Specified
Peripheral IV Size: RN Discretion
Additional PIV may be inserted as needed for repeat blood sampling or IV medication administration.
Nursing Procedure, Assessment and Monitoring
Hypersensitivity Monitoring (1)
Hypersensitivity reaction to bendamustine can occur.  For first and second dose, patient should be treated in a location
to optimize emergency care. See Emergency Medications.
Vital Signs
SEE COMMENTS Starting when released Until Specified
Obtain weight and vital signs. If patient's blood pressure is less than 100/60 mmHg, administer 500 mL saline bolus. See
conditional orders. Notify BMT team.
Flush Venous Access Device per Guidelines
Order details
sodium chloride flush 0.9% 10 mL injection
Flush, PRN Starting when released Until Discontinued, flush/line care
Flush per VAD guidelines.
heparin lock flush 10 UNIT/ML injection 1-150 units
1-150 units, Flush, PRN Starting when released Until Discontinued, flush/line care
Flush per VAD guidelines.
heparin 100 UNIT/ML lock flush injection 500 units
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Zztestonc,Jeff J [2507481]
11/16/2017 1:47:53 PM Page 1 of 11
Copyright © 2017 University of Wisconsin Hospitals and Clinics Authority
Contact: Lee Vermeulen, CCKM@uwhealth.org Last Revised: 11/2017CCKM@uwhealth.org

500 units, Flush, PRN Starting when released Until Discontinued, flush/line care
Implanted port use ONLY to be used when de-accessing port. Flush per VAD guidelines.
Hydration
sodium chloride 0.9 % infusion
at 20 mL/hr, Intravenous, ONCE, 1 dose Starting when released
To establish line and for flushing.
Pre-Medications
acetaMINOPHEN (TYLENOL) tab 650 mg
650 mg, Oral, ONCE, 1 dose Starting when released
Administer prior to chemotherapy.
diphenhydramine (BENADRYL) cap 25 mg
25 mg, Oral, ONCE, 1 dose Starting when released
Administer prior to chemotherapy.
ondansetron (ZOFRAN) tab 16 mg
16 mg, Oral, ONCE, 1 dose Starting when released
Administer prior to chemotherapy.
dexamethasone (DECADRON) tab 10 mg
10 mg, Oral, ONCE, 1 dose Starting when released
Administer prior to chemotherapy.
Emergency Medications
diphenhydramine (BENADRYL) injection 50 mg
50 mg, Intravenous, PRN, 1 dose Starting when released, infusion reaction, Administer over 1 Minutes
dexamethasone (DECADRON) 10 MG/ML injection 10 mg
10 mg, Intravenous, PRN, 1 dose Starting when released, infusion reaction
famotidine (PEPCID) injection 20 mg
20 mg, Intravenous, PRN, 1 dose Starting when released, infusion reaction
albuterol 2.5 mg/3 mL neb soln
2.5 mg, Nebulization, PRN, 1 dose Starting when released, infusion reaction
Treatment Medications
bendamustine (BENDEKA) 375 mg in sodium chloride 0.9 % 100 mL bag
375 mg (rounded from 370 mg = 200 mg/m2 × 1.85 m2 Treatment plan adjusted BSA), Intravenous, ONCE, 1 dose
Starting when released, Administer over 20 Minutes
Administer over 20 minutes. Hypersensitivity reaction to bendamustine can occur. For first and second dose, patient
should be treated in a location to optimize emergency care. See Emergency Medications.
Conditional Orders
sodium chloride 0.9% BOLUS
500 mL, Intravenous, ONCE PRN Starting when released Until Discontinued, dehydration, hypotension
Administer over 30 minutes if patient's blood pressure is less than 100/60 mmHg or if patient reports less than 4
glasses of water (8 oz) or one or more episodes of vomiting or two or more episodes of diarrhea in the previous 24
hours. Notify BMT team.
Take Home Medications
olanzapine (ZYPREXA) 5 MG tab
Take 1 tab by mouth one time daily at bedtime., 5 mg, Disp-7 tab, R-0, 1 X DAILY (HS) starting S, E-Prescribe
This medication will not be e-prescribed. If patient is present, script will go to printer. Otherwise,
script will go to nursing or tech pool.   Invalid items: Pharmacy   Details...
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Zztestonc,Jeff J [2507481]
11/16/2017 1:47:53 PM Page 2 of 11
Copyright © 2017 University of Wisconsin Hospitals and Clinics Authority
Contact: Lee Vermeulen, CCKM@uwhealth.org Last Revised: 11/2017CCKM@uwhealth.org

ondansetron (ZOFRAN) 8 MG tab
Take 1 tab by mouth every 8 hours as needed for nausea/vomiting., 8 mg, Disp-30 tab, R-5, EVERY 8
HOURS PRN starting S, Local Printer
prochlorperazine (COMPAZINE) 10 MG tab
Take 1 tab by mouth every 6 hours as needed for nausea/vomiting., 10 mg, Disp-30 tab, R-5, EVERY 6 HOURS PRN
starting S, Local Printer
acyclovir (ZOVIRAX) 400 MG tab
Take 1 tab by mouth 2 times daily., 400 mg, Disp-60 tab, R-5, 2 X DAILY starting S, Local Printer
Follow-Up
DAY -6 FOLLOW-UP
CHEMOTHERAPY ROOM APPOINTMENT: bendamustine for 60 minutes.
MULTIPLE DAY FOLLOW-UP (1)
DAY -5 THROUGH DAY -2: CHEMOTHERAPY ROOM APPOINTMENT: etoposide and cytarabine for 120 minutes.
MULTIPLE DAY FOLLOW-UP (2)
DAY -1: CHEMOTHERAPY ROOM APPOINTMENT: melphalan for 90 minutes.
MULTIPLE DAY FOLLOW-UP (3)
Beginning Day 0: Verify preadmission to B6/6 for Bone Marrow Transplantation.
Day -6, Conditioning Regimen Prior to BMT –  Planned for 11/17/2017
Treatment Plan Information
Treatment Plan Summary
DISEASE: Hodgkin or Non-Hodgkin Lymphoma; THERAPY: bendamustine 200 mg/m2 IV Day -7 and -6, etoposide 200
mg/m2 IV Day -5, -4, -3 and -2, cytarabine 400 mg/m2 IV Day -5, -4, -3 and -2, melphalan 140 mg/m2 IV Day -1,
GROWTH FACTOR REQUIRED; CYCLE LENGTH: 14 days; COURSE: 1 cycle.
Dose Calculation Instructions
All chemotherapy for BMT conditioning regimens should be dosed based on the medication-specific weight in
Standard Operating Procedure (SOP) B4.400: Calculation of High Dose Chemotherapy Doses. Document can be
accessed from the Reference Link of the Navigator.
IV Access
Insert and Maintain Peripheral IV
CONTINUOUS Starting when released Until Specified
Peripheral IV Size: RN Discretion
Additional PIV may be inserted as needed for repeat blood sampling or IV medication administration.
Nursing Procedure, Assessment and Monitoring
Hypersensitivity Monitoring (1)
Hypersensitivity reaction to bendamustine can occur.  For first and second dose, patient should be treated in a location
to optimize emergency care. See Emergency Medications.
Vital Signs
SEE COMMENTS Starting when released Until Specified
Obtain weight and vital signs. If patient's blood pressure is less than 100/60 mmHg, administer 500 mL saline bolus. See
conditional orders. Notify BMT team.
Monitoring Parameters (1)
If patient's blood pressure is less than 100/60 mmHg or if patient reports less than 4 glasses of water (8 oz) or one or
more episodes of vomiting or two or more episodes of diarrhea in the previous 24 hours, administer 500 mL saline
bolus. See conditional orders. Notify BMT team.
Flush Venous Access Device per Guidelines
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Zztestonc,Jeff J [2507481]
11/16/2017 1:47:53 PM Page 3 of 11
Copyright © 2017 University of Wisconsin Hospitals and Clinics Authority
Contact: Lee Vermeulen, CCKM@uwhealth.org Last Revised: 11/2017CCKM@uwhealth.org

Order details
sodium chloride flush 0.9% 10 mL injection
Flush, PRN Starting when released Until Discontinued, flush/line care
Flush per VAD guidelines.
heparin lock flush 10 UNIT/ML injection 1-150 units
1-150 units, Flush, PRN Starting when released Until Discontinued, flush/line care
Flush per VAD guidelines.
heparin 100 UNIT/ML lock flush injection 500 units
500 units, Flush, PRN Starting when released Until Discontinued, flush/line care
Implanted port use ONLY to be used when de-accessing port. Flush per VAD guidelines.
Hydration
sodium chloride 0.9 % infusion
at 20 mL/hr, Intravenous, ONCE, 1 dose Starting when released
To establish line and for flushing.
Pre-Medications
acetaMINOPHEN (TYLENOL) tab 650 mg
650 mg, Oral, ONCE, 1 dose Starting when released
Administer prior to chemotherapy.
diphenhydramine (BENADRYL) cap 25 mg
25 mg, Oral, ONCE, 1 dose Starting when released
Administer prior to chemotherapy.
ondansetron (ZOFRAN) tab 16 mg
16 mg, Oral, ONCE, 1 dose Starting when released
Administer prior to chemotherapy.
dexamethasone (DECADRON) tab 10 mg
10 mg, Oral, ONCE, 1 dose Starting when released
Administer prior to chemotherapy.
Emergency Medications
diphenhydramine (BENADRYL) injection 50 mg
50 mg, Intravenous, PRN, 1 dose Starting when released, infusion reaction, Administer over 1 Minutes
dexamethasone (DECADRON) 10 MG/ML injection 10 mg
10 mg, Intravenous, PRN, 1 dose Starting when released, infusion reaction
famotidine (PEPCID) injection 20 mg
20 mg, Intravenous, PRN, 1 dose Starting when released, infusion reaction
albuterol 2.5 mg/3 mL neb soln
2.5 mg, Nebulization, PRN, 1 dose Starting when released, infusion reaction
Treatment Medications
bendamustine (BENDEKA) 375 mg in sodium chloride 0.9 % 100 mL bag
375 mg (rounded from 370 mg = 200 mg/m2 × 1.85 m2 Treatment plan adjusted BSA), Intravenous, ONCE, 1 dose
Starting when released, Administer over 20 Minutes
Administer over 20 minutes. Hypersensitivity reaction to bendamustine can occur. For first and second dose, patient
should be treated in a location to optimize emergency care. See Emergency Medications.
Conditional Orders
sodium chloride 0.9% BOLUS
500 mL, Intravenous, ONCE PRN Starting when released Until Discontinued, dehydration, hypotension
Administer over 30 minutes if patient's blood pressure is less than 100/60 mmHg or if patient reports less than 4
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Zztestonc,Jeff J [2507481]
11/16/2017 1:47:53 PM Page 4 of 11
Copyright © 2017 University of Wisconsin Hospitals and Clinics Authority
Contact: Lee Vermeulen, CCKM@uwhealth.org Last Revised: 11/2017CCKM@uwhealth.org

glasses of water (8 oz) or one or more episodes of vomiting or two or more episodes of diarrhea in the previous 24
hours. Notify BMT team.
Follow-Up
VERIFY APPOINTMENTS
Verify next day appointment(s) have been scheduled. See follow-up section on Day 1.
Day -5, Conditioning Regimen Prior to BMT –  Planned for 11/18/2017
Treatment Plan Information
Treatment Plan Summary
DISEASE: Hodgkin or Non-Hodgkin Lymphoma; THERAPY: bendamustine 200 mg/m2 IV Day -7 and -6, etoposide 200
mg/m2 IV Day -5, -4, -3 and -2, cytarabine 400 mg/m2 IV Day -5, -4, -3 and -2, melphalan 140 mg/m2 IV Day -1,
GROWTH FACTOR REQUIRED; CYCLE LENGTH: 14 days; COURSE: 1 cycle.
Dose Calculation Instructions
All chemotherapy for BMT conditioning regimens should be dosed based on the medication-specific weight in
Standard Operating Procedure (SOP) B4.400: Calculation of High Dose Chemotherapy Doses. Document can be
accessed from the Reference Link of the Navigator.
IV Access
Insert and Maintain Peripheral IV
CONTINUOUS Starting when released Until Specified
Peripheral IV Size: RN Discretion
Additional PIV may be inserted as needed for repeat blood sampling or IV medication administration.
Nursing Procedure, Assessment and Monitoring
Vital Signs
EVERY 1 HOUR Starting when released Until Specified
Obtain weight. During etoposide infusion, check BP and HR every hour. If BP falls below 100 mmHg systolic or if
baseline BP less than 100 mmHg systolic but then decreases by 10%, stop infusion and administer 500 mL saline bolus.
See conditional orders. Notify BMT Team.
Monitoring Parameters (1)
If patient's blood pressure is less than 100/60 mmHg or if patient reports less than 4 glasses of water (8 oz) or one or
more episodes of vomiting or two or more episodes of diarrhea in the previous 24 hours, administer 500 mL saline
bolus. See conditional orders. Notify BMT team.
Hydration
sodium chloride 0.9 % infusion
at 20 mL/hr, Intravenous, ONCE, 1 dose Starting when released
To establish line and for flushing.
Pre-Medications
ondansetron (ZOFRAN) tab 16 mg
16 mg, Oral, ONCE, 1 dose Starting when released, Indications: Cancer Chemotherapy-Induced Nausea and Vomiting
Give prior to chemotherapy.
dexamethasone (DECADRON) tab 10 mg
10 mg, Oral, ONCE, 1 dose Starting when released, Indications: Cancer Chemotherapy-Induced Nausea and Vomiting
Give prior to chemotherapy.
Treatment Medications
etoposide (VEPESID) 392 mg in sodium chloride 0.9 % 1,000 mL NSS bag
392 mg (200 mg/m2 × 1.96 m2 Treatment plan BSA from recorded weight), Intravenous, ONCE, 1 dose Starting when
released
Administer over 60 to 90 minutes.
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Zztestonc,Jeff J [2507481]
11/16/2017 1:47:53 PM Page 5 of 11
Copyright © 2017 University of Wisconsin Hospitals and Clinics Authority
Contact: Lee Vermeulen, CCKM@uwhealth.org Last Revised: 11/2017CCKM@uwhealth.org

cytarabine PF (CYTOSAR) 784 mg in sodium chloride 0.9 % 250 mL bag
784 mg (400 mg/m2 × 1.96 m2 Treatment plan BSA from recorded weight), Intravenous, ONCE, 1 dose
Starting when released
Administer over 60 minutes.
Conditional Orders
sodium chloride 0.9% BOLUS
500 mL, Intravenous, PRN, 2 doses Starting when released, dehydration, hypotension
Administer over 30 minutes if patient's blood pressure is less than 100/60 mmHg or if patient reports less than 4
glasses of water (8 oz) or one or more episodes of vomiting or two or more episodes of diarrhea in the previous 24
hours. May repeat for hypotension during etoposide infusion. Notify BMT team.
Follow-Up
VERIFY APPOINTMENTS
Verify next day appointment(s) have been scheduled. See follow-up section on Day 1.
Day -4, Conditioning Regimen Prior to BMT –  Planned for 11/19/2017
Treatment Plan Information
Treatment Plan Summary
DISEASE: Hodgkin or Non-Hodgkin Lymphoma; THERAPY: bendamustine 200 mg/m2 IV Day -7 and -6, etoposide 200
mg/m2 IV Day -5, -4, -3 and -2, cytarabine 400 mg/m2 IV Day -5, -4, -3 and -2, melphalan 140 mg/m2 IV Day -1,
GROWTH FACTOR REQUIRED; CYCLE LENGTH: 14 days; COURSE: 1 cycle.
Dose Calculation Instructions
All chemotherapy for BMT conditioning regimens should be dosed based on the medication-specific weight in
Standard Operating Procedure (SOP) B4.400: Calculation of High Dose Chemotherapy Doses. Document can be
accessed from the Reference Link of the Navigator.
IV Access
Insert and Maintain Peripheral IV
CONTINUOUS Starting when released Until Specified
Peripheral IV Size: RN Discretion
Additional PIV may be inserted as needed for repeat blood sampling or IV medication administration.
Nursing Procedure, Assessment and Monitoring
Vital Signs
EVERY 1 HOUR Starting when released Until Specified
Obtain weight. During etoposide infusion, check BP and HR every hour. If BP falls below 100 mmHg systolic or if
baseline BP less than 100 mmHg systolic but then decreases by 10%, stop infusion and administer 500 mL saline bolus.
See conditional orders. Notify BMT Team.
Monitoring Parameters (1)
If patient's blood pressure is less than 100/60 mmHg or if patient reports less than 4 glasses of water (8 oz) or one or
more episodes of vomiting or two or more episodes of diarrhea in the previous 24 hours, administer 500 mL saline
bolus. See conditional orders. Notify BMT team.
Hydration
sodium chloride 0.9 % infusion
at 20 mL/hr, Intravenous, ONCE, 1 dose Starting when released
To establish line and for flushing.
Pre-Medications
ondansetron (ZOFRAN) tab 16 mg
16 mg, Oral, ONCE, 1 dose Starting when released, Indications: Cancer Chemotherapy-Induced Nausea and Vomiting
Give prior to chemotherapy.
dexamethasone (DECADRON) tab 10 mg
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Zztestonc,Jeff J [2507481]
11/16/2017 1:47:53 PM Page 6 of 11
Copyright © 2017 University of Wisconsin Hospitals and Clinics Authority
Contact: Lee Vermeulen, CCKM@uwhealth.org Last Revised: 11/2017CCKM@uwhealth.org

10 mg, Oral, ONCE, 1 dose Starting when released, Indications: Cancer Chemotherapy-Induced Nausea
and Vomiting
Give prior to chemotherapy.
Treatment Medications
etoposide (VEPESID) 392 mg in sodium chloride 0.9 % 1,000 mL NSS bag
392 mg (200 mg/m2 × 1.96 m2 Treatment plan BSA from recorded weight), Intravenous, ONCE, 1 dose Starting when
released
Administer over 60 to 90 minutes.
cytarabine PF (CYTOSAR) 784 mg in sodium chloride 0.9 % 250 mL bag
784 mg (400 mg/m2 × 1.96 m2 Treatment plan BSA from recorded weight), Intravenous, ONCE, 1 dose Starting when
released
Administer over 60 minutes.
Conditional Orders
sodium chloride 0.9% BOLUS
500 mL, Intravenous, PRN, 2 doses Starting when released, dehydration, hypotension
Administer over 30 minutes if patient's blood pressure is less than 100/60 mmHg or if patient reports less than 4
glasses of water (8 oz) or one or more episodes of vomiting or two or more episodes of diarrhea in the previous 24
hours. May repeat for hypotension during etoposide infusion. Notify BMT team.
Follow-Up
VERIFY APPOINTMENTS
Verify next day appointment(s) have been scheduled. See follow-up section on Day 1.
Day -3, Conditioning Regimen Prior to BMT –  Planned for 11/20/2017
Treatment Plan Information
Treatment Plan Summary
DISEASE: Hodgkin or Non-Hodgkin Lymphoma; THERAPY: bendamustine 200 mg/m2 IV Day -7 and -6, etoposide 200
mg/m2 IV Day -5, -4, -3 and -2, cytarabine 400 mg/m2 IV Day -5, -4, -3 and -2, melphalan 140 mg/m2 IV Day -1,
GROWTH FACTOR REQUIRED; CYCLE LENGTH: 14 days; COURSE: 1 cycle.
Dose Calculation Instructions
All chemotherapy for BMT conditioning regimens should be dosed based on the medication-specific weight in
Standard Operating Procedure (SOP) B4.400: Calculation of High Dose Chemotherapy Doses. Document can be
accessed from the Reference Link of the Navigator.
IV Access
Insert and Maintain Peripheral IV
CONTINUOUS Starting when released Until Specified
Peripheral IV Size: RN Discretion
Additional PIV may be inserted as needed for repeat blood sampling or IV medication administration.
Nursing Procedure, Assessment and Monitoring
Vital Signs
EVERY 1 HOUR Starting when released Until Specified
Obtain weight. During etoposide infusion, check BP and HR every hour. If BP falls below 100 mmHg systolic or if
baseline BP less than 100 mmHg systolic but then decreases by 10%, stop infusion and administer 500 mL saline bolus.
See conditional orders. Notify BMT Team.
Monitoring Parameters (1)
If patient's blood pressure is less than 100/60 mmHg or if patient reports less than 4 glasses of water (8 oz) or one or
more episodes of vomiting or two or more episodes of diarrhea in the previous 24 hours, administer 500 mL saline
bolus. See conditional orders. Notify BMT team.
Hydration
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Zztestonc,Jeff J [2507481]
11/16/2017 1:47:53 PM Page 7 of 11
Copyright © 2017 University of Wisconsin Hospitals and Clinics Authority
Contact: Lee Vermeulen, CCKM@uwhealth.org Last Revised: 11/2017CCKM@uwhealth.org

sodium chloride 0.9 % infusion
at 20 mL/hr, Intravenous, ONCE, 1 dose Starting when released
To establish line and for flushing.
Pre-Medications
ondansetron (ZOFRAN) tab 16 mg
16 mg, Oral, ONCE, 1 dose Starting when released, Indications: Cancer Chemotherapy-Induced Nausea and Vomiting
Give prior to chemotherapy.
dexamethasone (DECADRON) tab 10 mg
10 mg, Oral, ONCE, 1 dose Starting when released, Indications: Cancer Chemotherapy-Induced Nausea and Vomiting
Give prior to chemotherapy.
Treatment Medications
etoposide (VEPESID) 392 mg in sodium chloride 0.9 % 1,000 mL NSS bag
392 mg (200 mg/m2 × 1.96 m2 Treatment plan BSA from recorded weight), Intravenous, ONCE, 1 dose Starting when
released
Administer over 60 to 90 minutes.
cytarabine PF (CYTOSAR) 784 mg in sodium chloride 0.9 % 250 mL bag
784 mg (400 mg/m2 × 1.96 m2 Treatment plan BSA from recorded weight), Intravenous, ONCE, 1 dose Starting when
released
Administer over 60 minutes.
Conditional Orders
sodium chloride 0.9% BOLUS
500 mL, Intravenous, PRN, 2 doses Starting when released, dehydration, hypotension
Administer over 30 minutes if patient's blood pressure is less than 100/60 mmHg or if patient reports less than 4
glasses of water (8 oz) or one or more episodes of vomiting or two or more episodes of diarrhea in the previous 24
hours. May repeat for hypotension during etoposide infusion. Notify BMT team.
Follow-Up
VERIFY APPOINTMENTS
Verify next day appointment(s) have been scheduled. See follow-up section on Day 1.
Day -2, Conditioning Regimen Prior to BMT –  Planned for 11/21/2017
Treatment Plan Information
Treatment Plan Summary
DISEASE: Hodgkin or Non-Hodgkin Lymphoma; THERAPY: bendamustine 200 mg/m2 IV Day -7 and -6, etoposide 200
mg/m2 IV Day -5, -4, -3 and -2, cytarabine 400 mg/m2 IV Day -5, -4, -3 and -2, melphalan 140 mg/m2 IV Day -1,
GROWTH FACTOR REQUIRED; CYCLE LENGTH: 14 days; COURSE: 1 cycle.
Dose Calculation Instructions
All chemotherapy for BMT conditioning regimens should be dosed based on the medication-specific weight in
Standard Operating Procedure (SOP) B4.400: Calculation of High Dose Chemotherapy Doses. Document can be
accessed from the Reference Link of the Navigator.
IV Access
Insert and Maintain Peripheral IV
CONTINUOUS Starting when released Until Specified
Peripheral IV Size: RN Discretion
Additional PIV may be inserted as needed for repeat blood sampling or IV medication administration.
Nursing Procedure, Assessment and Monitoring
Vital Signs
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Zztestonc,Jeff J [2507481]
11/16/2017 1:47:53 PM Page 8 of 11
Copyright © 2017 University of Wisconsin Hospitals and Clinics Authority
Contact: Lee Vermeulen, CCKM@uwhealth.org Last Revised: 11/2017CCKM@uwhealth.org

EVERY 1 HOUR Starting when released Until Specified
Obtain weight. During etoposide infusion, check BP and HR every hour. If BP falls below 100 mmHg systolic or if
baseline BP less than 100 mmHg systolic but then decreases by 10%, stop infusion and administer 500 mL saline bolus.
See conditional orders. Notify BMT Team.
Monitoring Parameters (1)
If patient's blood pressure is less than 100/60 mmHg or if patient reports less than 4 glasses of water (8 oz) or one or
more episodes of vomiting or two or more episodes of diarrhea in the previous 24 hours, administer 500 mL saline
bolus. See conditional orders. Notify BMT team.
Hydration
sodium chloride 0.9 % infusion
at 20 mL/hr, Intravenous, ONCE, 1 dose Starting when released
To establish line and for flushing.
Pre-Medications
ondansetron (ZOFRAN) tab 16 mg
16 mg, Oral, ONCE, 1 dose Starting when released, Indications: Cancer Chemotherapy-Induced Nausea and Vomiting
Give prior to chemotherapy.
dexamethasone (DECADRON) tab 10 mg
10 mg, Oral, ONCE, 1 dose Starting when released, Indications: Cancer Chemotherapy-Induced Nausea and Vomiting
Give prior to chemotherapy.
Treatment Medications
etoposide (VEPESID) 392 mg in sodium chloride 0.9 % 1,000 mL NSS bag
392 mg (200 mg/m2 × 1.96 m2 Treatment plan BSA from recorded weight), Intravenous, ONCE, 1 dose Starting when
released
Administer over 60 to 90 minutes.
cytarabine PF (CYTOSAR) 784 mg in sodium chloride 0.9 % 250 mL bag
784 mg (400 mg/m2 × 1.96 m2 Treatment plan BSA from recorded weight), Intravenous, ONCE, 1 dose Starting when
released
Administer over 60 minutes.
Conditional Orders
sodium chloride 0.9% BOLUS
500 mL, Intravenous, PRN, 2 doses Starting when released, dehydration, hypotension
Administer over 30 minutes if patient's blood pressure is less than 100/60 mmHg or if patient reports less than 4
glasses of water (8 oz) or one or more episodes of vomiting or two or more episodes of diarrhea in the previous 24
hours. May repeat for hypotension during etoposide infusion. Notify BMT team.
Follow-Up
VERIFY APPOINTMENTS
Verify next day appointment(s) have been scheduled. See follow-up section on Day 1.
Day -1, Conditioning Regimen Prior to BMT –  Planned for 11/22/2017
Treatment Plan Information
Treatment Plan Summary
DISEASE: Hodgkin or Non-Hodgkin Lymphoma; THERAPY: bendamustine 200 mg/m2 IV Day -7 and -6, etoposide 200
mg/m2 IV Day -5, -4, -3 and -2, cytarabine 400 mg/m2 IV Day -5, -4, -3 and -2, melphalan 140 mg/m2 IV Day -1,
GROWTH FACTOR REQUIRED; CYCLE LENGTH: 14 days; COURSE: 1 cycle.
Dose Calculation Instructions
All chemotherapy for BMT conditioning regimens should be dosed based on the medication-specific weight in
Standard Operating Procedure (SOP) B4.400: Calculation of High Dose Chemotherapy Doses. Document can be
accessed from the Reference Link of the Navigator.
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Zztestonc,Jeff J [2507481]
11/16/2017 1:47:53 PM Page 9 of 11
Copyright © 2017 University of Wisconsin Hospitals and Clinics Authority
Contact: Lee Vermeulen, CCKM@uwhealth.org Last Revised: 11/2017CCKM@uwhealth.org

IV Access
Insert and Maintain Peripheral IV
CONTINUOUS Starting when released Until Specified
Peripheral IV Size: RN Discretion
Additional PIV may be inserted as needed for repeat blood sampling or IV medication administration.
Nursing Procedure, Assessment and Monitoring
Vital Signs
SEE COMMENTS Starting when released Until Specified
Obtain weight and vital signs. If patient's blood pressure is less than 100/60 mmHg, administer 500 mL saline bolus. See
conditional orders. Notify BMT team.
Monitoring Parameters (1)
If patient's blood pressure is less than 100/60 mmHg or if patient reports less than 4 glasses of water (8 oz) or one or
more episodes of vomiting or two or more episodes of diarrhea in the previous 24 hours, administer 500 mL saline
bolus. See conditional orders. Notify BMT team.
Patient Instructions(1)
RN instruct patient on cryotherapy to reduce incidence and severity of oral mucositis. Offer cryotherapy 10 minutes
before, during, and for a total of 60 minutes after melphalan administration. See Health Fact for You #7502 "Controlling
Mouth Sores from Melphalan".
Hydration
sodium chloride 0.9% BOLUS
500 mL, Intravenous, ONCE, 1 dose Starting when released, Administer over 30 Minutes
Infuse 500 mL over 30 minutes prior to melphalan.
Pre-Medications
fosaprepitant (EMEND) 150 mg in sodium chloride 0.9 % 250 mL bag
150 mg, Intravenous, ONCE, 1 dose Starting when released
Give prior to melphalan. Do not infuse with CA++, Mg++, Lactated Ringer's solutions
ondansetron (ZOFRAN) tab 24 mg
24 mg, Oral, ONCE, 1 dose Starting when released, Indications: Cancer Chemotherapy-Induced Nausea and Vomiting
Give prior to melphalan.
dexamethasone (DECADRON) tab 12 mg
12 mg, Oral, ONCE, 1 dose Starting when released, Indications: Cancer Chemotherapy-Induced Nausea and Vomiting
Give prior to melphalan.
Treatment Medications
melphalan (ALKERAN) injection 274.5 mg
274.5 mg (rounded from 274.4 mg = 140 mg/m2 × 1.96 m2 Treatment plan BSA from recorded weight), Intravenous,
ONCE, 1 dose Starting when released, Administer over 15 Minutes
Administer over 15 minutes. Pharmacist and RN must coordinate timing of administration to allow administration of
dose as close as possible to time of dose preparation due to poor stability and short expiration of drug. Drug must be
given within 60 minutes of reconstitution.
Conditional Orders
sodium chloride 0.9% BOLUS
500 mL, Intravenous, ONCE PRN Starting when released Until Discontinued, dehydration, hypotension
Administer over 30 minutes if patient's blood pressure is less than 100/60 mmHg or if patient reports less than 4
glasses of water (8 oz) or one or more episodes of vomiting or two or more episodes of diarrhea in the previous 24
hours. Notify BMT team.
Follow-Up
VERIFY APPOINTMENTS
Verify next day appointment(s) have been scheduled. See follow-up section on Day 1.
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Zztestonc,Jeff J [2507481]
11/16/2017 1:47:53 PM Page 10 of 11
Copyright © 2017 University of Wisconsin Hospitals and Clinics Authority
Contact: Lee Vermeulen, CCKM@uwhealth.org Last Revised: 11/2017CCKM@uwhealth.org

Day 0 through Day +6, Conditioning Regimen Prior to BMT –  Planned for 11/23/2017
Treatment Plan Information
Treatment Plan Summary
DISEASE: Hodgkin or Non-Hodgkin Lymphoma; THERAPY: bendamustine 200 mg/m2 IV Day -7 and -6, etoposide 200
mg/m2 IV Day -5, -4, -3 and -2, cytarabine 400 mg/m2 IV Day -5, -4, -3 and -2, melphalan 140 mg/m2 IV Day -1,
GROWTH FACTOR REQUIRED; CYCLE LENGTH: 14 days; COURSE: 1 cycle.
Dose Calculation Instructions
All chemotherapy for BMT conditioning regimens should be dosed based on the medication-specific weight in
Standard Operating Procedure (SOP) B4.400: Calculation of High Dose Chemotherapy Doses. Document can be
accessed from the Reference Link of the Navigator.
IV Access
Insert and Maintain Peripheral IV
CONTINUOUS Starting when released Until Specified
Peripheral IV Size: RN Discretion
Additional PIV may be inserted as needed for repeat blood sampling or IV medication administration.
Treatment Conditions
Verify Labs
Verify labs from BMT Admission Order Set with authorizing prescriber prior to releasing treatment medications and
document in a progress note.
Hydration
sodium chloride 0.9 % infusion
at 20 mL/hr, Intravenous, CONTINUOUS Starting when released Until Discontinued
To establish line and for flushing.
Supportive Care Medications
dexamethasone (DECADRON) tab 8 mg
8 mg, Oral, EVERY 24 HOURS, 2 doses Starting when released, Indications: Cancer Chemotherapy-Induced Nausea and
Vomiting
Day 0 and +1. May give IV if PO not tolerated.
dexamethasone (DECADRON) 10 MG/ML injection 8 mg
8 mg, Intravenous, EVERY 24 HOURS PRN, For 72 hours Starting when released, nausea/vomiting
Day 0 and +1. Give if PO not tolerated.
TBO-filgrastim (GRANIX) 300 MCG/0.5ML soln prefilled syringe
Subcutaneous, 1 X DAILY (PM) Starting S+5 As Scheduled
Start on Day +6. Discontinue when ANC is greater than 500/µL for 2 consecutive days.
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Zztestonc,Jeff J [2507481]
11/16/2017 1:47:53 PM Page 11 of 11
Copyright © 2017 University of Wisconsin Hospitals and Clinics Authority
Contact: Lee Vermeulen, CCKM@uwhealth.org Last Revised: 11/2017CCKM@uwhealth.org